Observer News. Dist. by HURINet. 10 December, 1996.

(Observer News): Last month, the parents of 4-year-old Amira
Hassan did what they thought was their duty as good
Muslims: They hired the family physician to snip off part of
her genitals.

When she died a few hours later, ...as a result of
complications from anesthesia, Mahmoud Hassan and his wife,
Atiyat, accepted it as God's will. Now the only thing that
puzzles them is why anyone thinks...the doctor, Ezzat
Shehat, did anything wrong.

"He is a good doctor," said Hassan, 27, a somber grocer with
a neatly trimmed mustache. "They should let him return to
work." The death of the little girl -- one of two who
suffered the same fate at the hands of the same doctor on
the same day -- highlights the immense challenge faced by
women's health advocates and some government officials in
Egypt as they begin to confront the widely practiced ritual
known as female circumcision.

Having ignored the issue for decades, public health
authorities in Egypt this year were stunned by a national
survey showing...97 percent of married Egyptian women
between the ages of 15 and 49 had undergone the procedure.
Among women with daughters, 87 percent reported...at least
one daughter had been circumcised or would be.

"They were all surprised," said Dara Carr, a researcher with
Maryland-based Macro International Inc., which conducted the
survey on behalf of the Egyptian government with funding
from the U.S. Agency for International Development. "I think
the Egyptians felt that this was a dying custom and...this
was much, much higher than they had expected."

Like other countries in Africa where female circumcision is
commonplace, Egypt has come under growing international
pressure to curb the practice. It has been linked to such
potentially fatal health risks as bleeding, infection and
complications relating to anesthesia -- and, in later life,
problems in childbirth and sexual relations. That pressure
led, in July, to a decree by Health Minister Ismail Sallam
barring health professionals from performing the operation.

...the decree has encountered stiff resistance from Islamic
fundamentalists, including many within the medical
establishment, who defend the practice as necessary to
protect women from the consequences of excessive sexual
desire.

Judging from a visit to this rural village, hemmed in by
sugar-cane fields on the west bank of the Nile 320 miles
south of Cairo, the ban has yet to touch the lives of
ordinary Egyptians. Many people said they had never heard of
it. Others said they would ignore it. And local prosecutors
acknowledged...they investigate circumcision cases with
little vigor, if at all.

In the meantime, health workers say, girls as young as 3
continue to undergo painful and sometimes risky surgery at
the hands of poorly trained midwives, village barbers and,
in many cases, doctors who work for the same ministry that
is claiming to combat the practice.

Human rights advocates are divided on the best way to combat
the phenomenon. Some say Egypt's parliament should make
female circumcision a criminal offense. Still others say the
government should concentrate on promoting public awareness
of the risks.

"People say...it is so deeply rooted that [making it a
criminal offense] will just drive it underground," said
Marie Assaad, who chairs a coalition of Egyptian
nongovernmental organizations that is trying to combat the
problem. "Many doctors still believe it is a very important
protection against disease and immorality and that talking
against it is a Western fad."

Among religious conservatives in Egypt, female circumcision
is typically defended on the basis of sayings attributed to
the prophet Muhammad. But others contend the practice has no
basis in Islam. They note...it is unknown in
ultraconservative Islamic countries such as Saudi Arabia and
Iran, occurs widely within Egypt's Coptic Christian minority
and may date to the time of the pharaohs, long before the
advent of Islam.

In sub-Saharan Africa, female circumcision is a tribal
custom that occurs across a broad spectrum of religions and
cultures in more than 20 countries. The operation can range
in severity from partial or full removal of the clitoris and
surrounding tissue to a radical procedure in which the
external genitals are cut away and the area closed with
stitches, leaving only a small opening for urination and
menstruation.

Egypt's government and official media largely ignored the
subject until 1994, when CNN broadcast footage of a
screaming 10-year-old Egyptian girl undergoing the procedure
at the hands of a Cairo barber.

After initially accusing the network of trying to embarrass
Egypt in front of foreign guests then in Cairo for a U.N.
conference on population, the government promised action.
...it soon ran into opposition from the Gad Haq Ali Gad Haq,
then Egypt's senior religious figure and the sheik of
Cairo's Al Azhar University, who warned..."girls who are not
circumcised when young have a sharp temperament and bad
habits."

Ali Fattah, health minister at the time, tried to finesse
the issue by declaring...public hospitals would perform the
operation only one day a week. When Egyptian women's groups
complained, he banned the procedure in public hospitals, but
not in private ones.

Sallam, the current health minister, has tried to close that
loophole, announcing in July...no licensed health
professional could perform the procedure. Sallam
acknowledged in an interview...the Health Ministry has
suspended or revoked the licenses of doctors in just two
circumcision cases, both of them involving deaths.

The government faces strong resistance from Egyptian doctors
such as Munir Mur, a British-trained professor of gynecology
at Cairo's Ain Shams University with a thriving private
practice in the upscale suburb of Heliopolis. Although Mur
condemns the more extreme varieties of circumcision -- he
said his method removes a fold over the clitoris while
leaving the clitoris intact -- he has sued to overturn the
ministry's ban on grounds...it is contrary both to Islam and
sound medical practice.

"Most of our parents, mothers, aunts, sisters and so on have
been doing this for years, and no one was complaining," Mur
said in an interview.

Attitudes are even more entrenched in such rural villages as
this warren of mud-brick houses and narrow alleys just a few
miles from the five-star tourist palaces of Luxor on the
opposite bank.

"Even if the law prohibits it, people will still do this
operation," said Hoda Abdelmoreed, 29, a vivacious mother of
three who teaches Arabic and religion at a high school in
nearby Armant.

"Europe and the United States," she added, "need it more
than we do. They wouldn't have AIDs and all these other
problems."

When the parents of Amira Hassan decided...she should be
circumcised, they turned to Shehat, the family doctor, who
worked at the shabby, two-story village clinic run by the
Egyptian Health Ministry.

Shehat had arranged to perform the operation along with two
other circumcisions on the morning of Oct. 13. According to
Mahmoud Hassan, he injected Amira with a general anesthetic
and then circumcised her in the family living room, a
cramped, filthy space lined with particle-board benches.

On the same morning, Shehat performed the operation another
girl, 3-year-old Warda Sayed. The two girls died several
hours later, apparently as a result of complications from
the anesthetic. The third girl survived. Shehat then
returned to the houses of the two dead girls, where he
filled out certificates listing the cause of death as
"natural." Shehat declined to comment.

The Health Ministry has suspended Shehat pending the outcome
of the criminal investigation. But the doctor is still
living at the clinic with his wife. Sameh Bahiry, an
assistant prosecutor in Armant, said he does not expect
charges to be filed. "We have no evidence against him," he
said in an interview. "Circumcision is not illegal in
Egypt."